Remote Behavioral Health Utilization Clinician

CVS Health; Fulton (MS); Remote; USD 54,000 - 143,000; Full time

Benefits offered by this job

Remote position

Shift differential 12.5%

Benefits package

Job summary

CVS Health is seeking a Behavioral Health Utilization Management Clinician for a 100% remote, nationwide role with weekend hours and holiday availability. The position involves reviewing preauthorization requests, coordinating decisions with providers, and applying clinical judgment to ensure appropriate behavioral health care.

The role requires an active behavioral health license (LPC/LMHC/LCMHC or RN) and 3+ years of post-licensure experience in mental health and substance use disorders, with

Qualifications

• Active, unrestricted independent behavioral health clinical license in your state of residence.
• LPC, LMHC, LCMHC or RN licensure options.
• Minimum 3+ years of post-licensure behavioral health experience.
• 3+ years of experience with mental health and substance use disorders.
• Ability to manage telephonic and computer-based work simultaneously.
• Hospital-based behavioral health experience.
• Utilization Management or Prior Authorization experience.
• Managed Care experience.

Responsibilities

• Review preauthorization requests for behavioral health services using evidence-based guidelines and clinical judgment.
• Coordinate, document, and communicate utilization management decisions with providers and stakeholders.
• Ability to manage crisis calls, apply clinical judgment to assess risk, determine support needs, and coordinate interventions including escalation for suicide risk.
• Apply clinical expertise to support quality, cost-effective care and positive member outcomes.
• Work in a fast-paced, queue-based environment while managing multiple priorities.
• Collaborate with providers and care teams to facilitate appropriate levels of care.

Skills

Clinical judgment

Crisis management

Telephonic communication

Care coordination

Multitasking in fast-paced environment

Education

Master's degree in Social Work, Counseling, or Psychology

RN with Behavioral Health emphasis or Psychology

Job description

CVS Health is seeking a Behavioral Health Utilization Management Clinician for a 100% remote, nationwide role with weekend hours and holiday availability. The position involves reviewing preauthorization requests, coordinating decisions with providers, and applying clinical judgment to ensure appropriate behavioral health care.

The role requires an active behavioral health license (LPC/LMHC/LCMHC or RN) and 3+ years of post-licensure experience in mental health and substance use disorders, with